Boise State University
Faculty Voluntary Phased Retirement Agreement
Complete this form and return it to Human Resource Services with the required signatures and attachments
by the application deadline.
Deadline dates: January 15 for phased retirement plans beginning the following fall semester. July 15 for
phased retirement plans beginning the following spring semester.
_________________________________________________ ___________________________
Name (Please Print) Date
_________________________________________________ ___________________________
Academic Department School/College
Annual Salary at time of retirement $ __________________ (not including grants, supplemental pay, etc.)
If accepted in this program, I agree to the following salary levels for the following semesters:
(Note: The combined percentage of Fall and Spring semester salaries cannot exceed 49%.)
Year 1: Fall Semester 20 ___; _____ %; $_________ Spring Semester 20 ___; ____%; $___________
Year 2: Fall Semester 20 ___; _____ %; $_________ Spring Semester 20 ___; ____%; $___________
Year 3: Fall Semester 20 ___; _____ %; $_________ Spring Semester 20 ___; ____%; $ ___________
By my signature below, I certify that:
1. I voluntarily seek to participate in the Phased Retirement Program. I have read the full description
and I understand the provisions.
2. I have consulted with my immediate academic supervisor regarding the work expectations
indicated above. Attached is my Phased Retirement Plan, including percentage of time teaching,
doing research and/or service as approved by the appropriate Chair, Dean and Provost.
3. I understand that my total combined earnings, including any appointments with the University in
addition to the phased retirement agreement, cannot exceed 49% of my previous contract earnings
per academic year.
4. I have consulted with the University’s Benefits Representative in Human Resource Services and I
understand any changes/limitations to my full-time benefits that will commence upon approval of
this Phased Retirement Plan.
5. If accepted into this Program, I hereby resign my tenured faculty position, if appropriate, and retire
from Boise State University at the conclusion of ___________ (Fall/Spring) semester,
_______(year). I understand that this agreement supersedes any other agreement or understanding
between the University and me regarding the date and terms of resignation of my faculty position.
Faculty Member’s Signature: _______________________________________ Date: _______________
I concur with the attached description of the applicant’s work responsibilities:
Department Chair: _______________________________________________ Date: ________________
Dean: _________________________________________________________ Date: ________________
The following signatures represent concurrence with the above terms of this proposal:
Provost/Vice President Academic Affairs: ____________________________ Date: ________________
University Benefits Representative: _________________________________ Date: ________________
10/09
